Publications by authors named "J W Awori Hayanga"

75 Publications

Robotic Aortic Valve Replacement: First 50 Cases.

Ann Thorac Surg 2021 Sep 21. Epub 2021 Sep 21.

Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV. Electronic address:

Background: Existing management challenges in selecting transcatheter versus surgical aortic valve replacement (SAVR) include bicuspid stenosis, low clinical risk, horizontal valve position, aortic insufficiency (AI), and need for concomitant procedures or mechanical valves. To address these gaps, we present our early experience with fully robotic-assisted aortic valve replacement (RAVR).

Methods: Between January 2020 and February 2021, 50 consecutive RAVR operations were performed utilizing a 3-4 cm lateral mini-thoracotomy three-port technique with transthoracic aortic clamping, similar to our robotic mitral platform. Conventional SAVR prostheses were implanted with interrupted braided sutures in all cases.

Results: Median age was 67.5 years, BMI was 29, calcified bicuspid disease was present in 28/50 (56%), and severe AI in 8/50 (16%). Ejection fraction was 54.8±8.4% (mean±SD), and STS PROM was 1.54±0.7%. Mechanical prostheses were used in 16/50 (32%), and 7 required concomitant procedures including Cox-Maze (3), left atrial appendage clipping (1), aortic root enlargement (2), mitral repair (1), and left atrial myxoma excision (1). Median times for cardiopulmonary bypass, cross-clamp, valvectomy, annular sutures, and aortotomy closure were 166, 117, 4, 20, and 31 minutes, respectively. All times plateaued after the initial five cases. Most patients (42/50, 84%) were extubated in the operating room, and the remainder (8/50, 16%) within 4 hours. There was no 30-day operative mortality or stroke. All had 30-day echocardiography demonstrating no valvular or perivalvular abnormalities.

Conclusions: RAVR appears to have procedural safety and short-term outcomes to rival alternatives. Incremental experience may facilitate the safe performance of concomitant procedures as deemed necessary.
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http://dx.doi.org/10.1016/j.athoracsur.2021.08.036DOI Listing
September 2021

Anesthetic choice for arteriovenous access creation: A National Anesthesia Clinical Outcomes Registry analysis.

J Vasc Access 2021 Sep 21:11297298211045495. Epub 2021 Sep 21.

Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, Morgantown, WV, USA.

Background: We sought to evaluate differences in primary anesthetic type used in arteriovenous access creation with the hypothesis that administration of regional anesthesia and monitored anesthesia care (MAC) with local anesthesia as the primary anesthetic has increased over time.

Methods: National Anesthesia Clinical Outcomes Registry data were retrospectively evaluated. Covariates were selected a priori within multivariate models to determine predictors of anesthetic type in adults who underwent elective arteriovenous access creation between 2010 and 2018.

Results: A total of 144,392 patients met criteria; 90,741 (62.8%) received general anesthesia. The use of regional anesthesia and MAC decreased over time (8.0%-6.8%, 36.8%-27.8%, respectively; both  < 0.0001). Patients who underwent regional anesthesia were more likely to have ASA physical status >III and to reside in rural areas (52.3% and 12.9%, respectively; both  < 0.0001). Patients who underwent MAC were more likely to be older, male, receive care outside the South, and reside in urban areas (median age 65, 56.8%, 68.1%, and 70.8%, respectively; all  < 0.0001). Multivariate analysis revealed that being male, having an ASA physical status >III, and each 5-year increase in age resulted in increased odds of receiving alternatives to general anesthesia (regional anesthesia adjusted odds ratios (AORs) 1.06, 1.12, and 1.26, MAC AORs 1.09, 1.2, and 1.1, respectively; all  < 0.0001). Treatment in the Midwest, South, or West was associated with decreased odds of receiving alternatives to general anesthesia compared to the Northeast (regional anesthesia AORs 0.28, 0.38, and 0.03, all  < 0.0001; MAC 0.76, 0.13, and 0.43, respectively; all  < 0.05).

Conclusions: Use of regional anesthesia and MAC with local anesthesia for arteriovenous access creation has decreased over time with general anesthesia remaining the primary anesthetic type. Anesthetic choice, however, varies with patient characteristics and geography.
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http://dx.doi.org/10.1177/11297298211045495DOI Listing
September 2021

Staffing in a Level 1 Trauma Center: Quantifying Capacity for Preparedness.

Disaster Med Public Health Prep 2021 Sep 15:1-7. Epub 2021 Sep 15.

Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, Morgantown, West Virginia, USA.

Objective: We sought to determine who is involved in the care of a trauma patient.

Methods: We recorded hospital personnel involved in 24 adult Priority 1 trauma patient admissions for 12 h or until patient demise. Hospital personnel were delineated by professional background and role.

Results: We cataloged 19 males and 5 females with a median age of 50-y-old (interquartile range [IQR], 35.5-67.5). The average number of hospital personnel involved was 79.71 (standard deviation, 17.62; standard error 3.6). A median of 51.2% (IQR, 43.4%-59.8%) of personnel were first involved within hour 1. More personnel were involved in direct versus indirect care (median 54.5 [IQR, 47.5-67.0] vs 25.0 [IQR, 22.0-30.5]; P < 0.0001). Median number of health-care professionals and auxiliary staff were 74.5 (IQR, 63.5-90.5) and 6.0 (IQR, 5.0-7.0), respectively. More personnel were first involved in hospital locations external to the emergency department (median, 53.0 [IQR, 41.5-63.0] vs 27.5 [IQR, 24.0-30.0]; P < 0.0001). No differences existed in total personnel by Injury Severity Score (P = 0.1266), day (P = 0.7270), or time of admission (P = 0.2098).

Conclusions: A large number of hospital personnel with varying job responsibilities respond to severe trauma. These data may guide hospital staffing and disaster preparedness policies.
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http://dx.doi.org/10.1017/dmp.2021.269DOI Listing
September 2021

Acute Kidney Injury in Extracorporeal Membrane Oxygenation Patients: National Analysis of Impact of Age.

Blood Purif 2021 Sep 7:1-10. Epub 2021 Sep 7.

Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Background: The aim of this study was to determine epidemiology and outcomes of acute kidney injury (AKI) in patients on extracorporeal membrane oxygenation (ECMO) and to assess if age modifies the effect of AKI on mortality.

Methods: Using National (Nationwide) Inpatient Sample Database for hospitalizations in the USA from 2003 to 2014, we identified adult patients on ECMO support. Using International Classification of Diseases 9th Revision, we assessed the rates of AKI and AKI requiring dialysis (AKI-D) among them and associated survival. We used a multivariable logistic regression to identify risk factors of and differential effect of age on mortality from AKI.

Results: AKI was seen in 63.9% of 17,942 ECMO hospitalizations: 21.9% of those with AKI required dialysis. The percentage of those with AKI increased steadily. Mortality was higher in those with AKI, with highest in those with AKI-D (70.8% vs. 61.7%; p < 0.001). While both age and AKI were independent predictors of mortality, age was neither a risk factor for AKI nor did it modify the effect of AKI on mortality.

Conclusions: AKI is common and is increasing among patients on ECMO support. Patients on ECMO have high mortality and AKI is an independent predictor of mortality. Though age is also an independent predictor of mortality in patients on ECMO, it is neither a predictor of AKI nor does not modify the relationship between AKI and mortality.
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http://dx.doi.org/10.1159/000518346DOI Listing
September 2021

Commentary: Mitigating the other pandemic.

JTCVS Tech 2021 Aug 25. Epub 2021 Aug 25.

Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, WVa.

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http://dx.doi.org/10.1016/j.xjtc.2021.08.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417728PMC
August 2021
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